Whole Bowel Irrigation

Another technique for clearing the gut is whole bowel irrigation, which involves the installation of large volumes of polyethylene glycol in an electrolyte and osmotically balanced solution that neither causes fluid nor electrolyte shifts. This technique is accomplished in adults by the installation of 2 L/h polyethylene glycol solution either by mouth or through an nasogastric tube or, in children, by the installation of 50 to 250 mL/kg/h or as much of polyethylene glycol solution as tolerated. The end point is clear rectal effluent. When done properly, this technique produces a rapid catharsis by mechanically forcing ingested substances through the bowel at a rapid rate.

Contraindications include patients with preceding diarrhea, ingestions that are expected to result in significant diarrhea (except for heavy metals, as these substances do not adsorb well to activated charcoal) and patients with absent bowel sounds or with obstruction. The complications included bloating, cramping, and rectal irritation from frequent bowel movements. Close nursing care is needed to maintain patient cleanliness.

Controlled studies clearly demonstrating improvement in clinical outcome after this procedure are lacking, but many authors describe limited symptomatology following potentially toxic doses of substances known not to adsorb to activated charcoal.15 Common indications for whole bowel irrigation include ingestion of sustained-release preparations, and ingestions that are known not to adsorb to activated charcoal; substances that form bezoars; in clinical situations where nonobstructive, nonsharp foreign bodies are present in the bowel (such as drug vials); and, in cases of illicit drug body packing.

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